Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes

Nolan J Brown; Cathleen Kuo; Zach Pennington; Angie Zhang; Ashley E Choi; Andrew K Chan; Shane Shahrestani; Nicholas E Bui; Matthew J Hatter; Gaston Camino-Willhuber; Martin H Pham; Michael Y Oh

doi:10.1097/BSD.0000000000001644

Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes

Clin Spine Surg. 2024 Oct 25. doi: 10.1097/BSD.0000000000001644. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, University of California, Irvine, Orange, CA.
² Department of Neurosurgery, University at Buffalo School of Medicine, Buffalo, NY.
³ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
⁴ California University of Science and Medicine, San Bernardino, CA.
⁵ Department of Neurosurgery, New York Presbyterian/Columbia University Medical Center, New York, NY.
⁶ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles.
⁷ Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda.
⁸ Department of Neurosurgery, University of California, San Diego, CA.

PMID: 39450872
DOI: 10.1097/BSD.0000000000001644

Abstract

Summary of background data: Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina.

Objective: We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes.

Study design: Systematic review of the current literature using PRISMA 2020 recommendations.

Methods: We queried the literature and systematically selected relevant studies according to PRISMA guidelines.

Results: Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24 h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures.

Conclusions: In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.